FMLA Form WH-380-E – Fill Out Online

FMLA Form WH-380-E, Employee’s Serious Health Condition, is the form you need to submit to your employer to let them know you’re using your FMLA leave. It’s the form that shouldn’t be mistaken with the other FMLA forms. Use Form WH-380-E only if you’re using your FMLA leave for your serious health condition.

Contents of Form WH-380-E

Form WH-380-E is made up of two primary sections. The first section details the employee’s information, while the second is filled out by the healthcare provider outlining the employee’s health condition. Both sections must be filed to meet the FMLA guidelines appropriately.

Employer’s section

This part requires identifying the employer by entering their name, the date medical certification needs to be returned, and information about the employee.

Healthcare provider section

This is the section that needs to be filed by the healthcare provider. Generally, as the employee, you need to take it to your primary care doctor, such as your physician. 

This section will detail your medical information, such as whether or not you need inpatient care, chronic conditions, permanent or long-term conditions, pregnancy, and more. It will also detail the number of days you need to recover, which will be roughly around the same days as the FMLA leave you’ll need, and point out your essential job function(s) that you won’t be able to fulfill due to the health condition. 

Your primary healthcare provider files the healthcare provider section. Make sure not to enter any information here yourself. It must be filed by them.

Fill out Form WH-380-E online

Start filling out a copy of Form WH-380-E online from the above link. Once completed, save it as a PDF file to print out a paper copy to furnish your employer. 

Considering that you don’t need to file this form with the Department of Labor or any other government agency, you’ll need to keep one copy for your own records. Although this is entirely optional, it would be best if you kept a copy in case of a violation by your employer. 

Additionally, you can also email it to your healthcare provider if you aren’t able to take it to them for reasons such as being an in-house patient.